Abstract
BackgroundWe conducted a prospective study in a cohort of short-term travelers assessing the incidence rate of anti-circumsporozoite seroconversion, adherence to chemoprophylaxis, symptoms of malaria during travel, and malaria treatment abroad.MethodsAdults were recruited from the travel clinic of the Public Health Service Amsterdam. They kept a structured daily travel diary and donated blood samples before and after travel. Blood samples were serologically tested for the presence of Plasmodium falciparum anti-circumsporozoite antibodies.ResultsOverall, the incidence rate (IR) of anti-circumsporozoite seroconversion was 0.8 per 100 person-months. Of 945 travelers, 620 (66%) visited high-endemic areas and were advised about both chemoprophylaxis and preventive measures against mosquito bites. Most subjects (520/620 = 84%) took at least 75% of recommended prophylaxis during travel. Travel to Africa, use of mefloquine, travel duration of 14–29 days in endemic areas, and concurrent use of DEET (N,N-diethyl-meta-toluamide) were associated with good adherence practices. Four travelers without fever seroconverted, becoming anti-circumsporozoite antibody-positive. All four had been adherent to chemoprophylaxis; two visited Africa, one Suriname, one India. Ten subjects with fever were tested for malaria while abroad and of these, three received treatment. All three were adherent to chemoprophylaxis and tested negative for anti-circumsporozoite antibodies.ConclusionTravel to Africa, using mefloquine, travel duration of 14–29 days in endemic areas, and use of DEET were associated with good adherence to chemoprophylaxis. The combination of chemoprophylaxis and other preventive measures were sufficient to protect seroconverting travelers from clinical malaria. Travelers who were treated for malaria abroad did not seroconvert.
Highlights
Half the world’s population is at risk of malaria [1,2]
Risk estimates for malaria infection among travelers from nonendemic countries are usually based on transmission rates in endemic populations and reports of infections in returned tourists
The other 325 participants traveled to low-endemic areas
Summary
An estimated 216 million malaria cases, and 655,000 deaths, occurred in 2010, mostly among the local population in malaria-endemic regions [2]. Malaria is a threat to the approximately 80–90 million travelers who visit the 106 endemic countries annually. Travelers can protect themselves against malaria by using antimalarial chemoprophylaxis and preventive measures against mosquito bites. Recommendations for these preventive measures are based on the anticipated infection rate and drug resistance in Plasmodium falciparum [3,4,5], and differ by country. Risk estimates for malaria infection among travelers from nonendemic countries are usually based on transmission rates in endemic populations and reports of infections in returned tourists. We conducted a prospective study in a cohort of short-term travelers assessing the incidence rate of anticircumsporozoite seroconversion, adherence to chemoprophylaxis, symptoms of malaria during travel, and malaria treatment abroad
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